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Table 1 Laboratory and imaging tests performed after development of acral ischemia

From: Acral vascular necrosis associated with immune-check point inhibitors: case report with literature review

 

Tests Performed

Results

Infection

CBC, CRP

Blood cultures

Echocardiography

HBV, HCV

Normal

Negative

No vegetation or myxoma

Negative

Hypercoagulable state

Protein C

Protein S

Anti- thrombin 3

Platelet

PT/aPTT/INT

131% (Normal)

73% (Normal)

Normal

280 10 × 3/uL (Normal)

Normal

Lymphoproliferative disease

Kappa/Lambda Ratio

Beta-2 microglobulin (B2M)

LDH

SPEP/IFE

1.37 (Normal)

3 mg/L (Mildly elevated)

138 U/L (Normal)

Normal

Tumor invasion

CT Chest

CT Angiography

No invasion of sympathetic nervous plexus

No vascular occlusion, saccular aneurysm or stenosis up to the palmar arch arteries

Autoimmune and inflammatory disease / Thromboangiitis obliterans

ANA

ESR

CH50

ANCA-c, ANCA-p

Cryoglobulin

APL ab, Anti-Scl-70 Ab, Anti-dsDNA ab, Anti-U1 RNP Ab, Anti-Sm ab, Anti-Ro/SSA ab

Nailfold videocapillaroscopy

Skin biopsy

1:80 Homogeneous

70 mm/hr

170 CAE Units (elevated)

(Acute phase reactant)

Normal

Negative (Normal)

Not performed

Not performed

Not performed

  1. Ab: antibodies, APL: antiphospholipid, Anti-Scl-70: topoisomerase I, ANCA-c: Central anti-neutrophil cytoplasmic antibodies, ANCA-p: perinuclear anti- neutrophil cytoplasmic antibodies, Anti-Sm: anti smith antibodies, Anti-Ro/SSA: anti sjögren’s syndrome related antigen A, SPEP: serum protein electrophoresis, IFE: immunofixation electrophoresis